Optimizing Inpatient Nutrition Care of Adult Patients with Inflammatory Bowel Disease in the 21st Century

Abstract

Malnutrition is highly prevalent in inflammatory bowel disease (IBD) patients and disproportionately affects those admitted to hospital. Malnutrition is a risk factor for many complications in IBD, including prolonged hospitalization, infection, greater need for surgery, development of venous thromboembolism, post-operative complications, and mortality. Early screening for malnutrition and prompt nutrition intervention if indicated has been shown to prevent or mitigate many of these outlined risk factors. There are many causes of malnutrition in IBD including reduced oral food intake, medications, active inflammation, and prior surgical resections. Hospitalization can further compound pre-existing malnutrition through inappropriate diet restrictions, nil per os (NPO) for endoscopy and imaging, or partial bowel obstruction, resulting in "post-hospital syndrome" after discharge and readmission. The aim of this article is to inform clinicians of the prevalence and consequences of malnutrition in IBD, as well as available screening and assessment tools for diagnosis, and to offer an organized approach to the nutritional care of hospitalized adult IBD patients.

Keywords: central parenteral nutrition; enteral nutrition; inflammatory bowel disease; malnutrition; nutrition support; peripheral parenteral nutrition; sarcopenia.

Figure 1

Multifactorial mechanisms of malnutrition in inflammatory bowel disease (IBD).

Figure 2

Proposed algorithm for nutrition support in hospitalized IBD patients. CPN, central parenteral nutrition; EN, enteral nutrition; ONS, oral nutritional supplement; PO, per os; PPN, peripheral parenteral nutrition.

Figure 3

In the setting of malnutrition, IBD surgery should be delayed for 7–14 days to allow for nutritional intervention, if safe to do so, such as in the case of fibrostenotic strictures or stable intra-abdominal abscess in Crohn’s disease (CD). In the setting of emergency IBD surgery in a malnourished patient, such as with fulminant Ulcerative colitis (UC) or perforated bowel obstruction, post-operative EN and/or PN should be initiated immediately if the patient will not be able to resume full diet within 7 days of surgery. Enhanced recovery after surgery (ERAS) protocols should be applied, with oral intake and/or EN initiated within 24 h of surgery [60].